1. Preventive orthodontics

2. Prevention is not only better than cure but more
stable and cheaper as well.

3. What is the ideal time to start orthodontic
treatment?

4. Graber: preventive orthodontics as the action
taken to preserve the integrity of what
appears to be a normal occlusion at a specific
time.

5. • Profitt and Ackermann -has defined as
prevention of potential interference with
occlusal development.

6. Interceptive orthodontics
• that phase of the science and art of
orthodontics employed to recognize and
eliminate potential irregularities and
malpositions in the developing dentofacial
complex.

7. Preventive procedures: in anticipation of
development of problem
Interceptive procedures:after the problem is
manifested

8. • The importance of deciduous dentition
• Awareness about the preservation of primary
teeth
• The impact of primary teeth integrity on
permanent teeth

9. • The responsibility of pedodontists
• General practioners
• Orthodontists

10. Preventive procedures
1. Caries control
2. Parent counselling/education
3. Space maintenance
4. Exfoliation of deciduous teeth
5. Abnormal frenal attachments
6. Treatment of locked permanent first molars
7. Abnormal oral musculature and related habits
8. Supernumeraries management
9. Management of ankylosed teeth.

11. Parent education
• 1.pre-natal counselling----?
• 2.post-natal------?
• 3.nutrition----role
• 4.feeding of child----?
• 5.?

12. Research shows
• possible corelationship between the mothers'
poor oraI hygiene and premature births.

13. Prenatal counseling may involve the following:
i. The importance of oral hygiene maintenance by the mother.
ii. How irregular eating and hunger pangs by the mother can result in her
developing decayed teeth, which can be quite painful on pulpal
involvement, especially during the third trimester of pregnancy.
ill. Recent studies have indicated a possible corelationship between the mothers'
poor oraI hygiene and premature births.
iv. A mother suffering from pregnancy induced diabetes mellitus, would be more
difficult to manage during the pregnancy period especially if her oral hygiene is
poor.
v. The increased risk of a mother suffering from poor oral hygiene transmitting
the strains of caries inducing bacteria to the baby on sharing the same feeding
spoon or on tasting the food with the same are high.

14. Six months to One-year of Age
This is the most important period of counseling. The
parents are made aware of:
i. Teething and the associated irritation, slight loose motions are possible in
mildly elevated febrile condition.
ii. Most of the parents are appalled on seeing the deciduous teeth erupting in
rotated positions. Awareness to be brought about as to how they are in that
position and that they would eventually straighten out on erupting fully.
iii. No sugar addition to bottle milk, however mothers' milk is preferred and the
best for the TMJdevelopment as well as for non- development of tongue
thrusting habits.
iv. Brushing with the help of a finger brush during bathing should be introduced.
Cleaning of the deciduous dentition with a clean, soft cotton cloth dipped in
warm saline is also recommended, to prevent the initiation of nursingor rampant
caries
v. Child should be initiated to drinking from a glass by one year of age.

15. Two years of Age
i. Bottle-feeding if previously initiated should never be given during the passage to
sleep. Bottlefeeding to be withdrawn completely by 18 to 24
months of age. These would decrease the chances of initiation of decay and the
potential for nursing
caries.
ii. Brushing to be initiated post-breakfast and post dinner.
iii, Clinical examination to assess any incipient decay and eruption status of teeth.

16. Three years of Age
i. Clinical examination-generally the full compliment of deciduous
dentition should have erupted by now. To assess the occlusion, molar
and canine
relationships and if there is the presence of any discrepancies away
from the normal, e.g. unilateral cross bite ,supernumerary teeth
,missing teeth, fused teeth, etc.
ii. Oral habits such as thumb sucking, lip sucking, oral breathing, etc.
and their effects on the development of occlusion should be
considered.
iii. To assess clinically for incomplete eruption of deciduous second
molars/pericoronal flaps may lead to decay on the same.
iv. Child to be encouraged to begin brushing on hisown at least once a
day-preferably postbreakfast.

17. Five to Six years of Age
i. Parents to be informed about the initiation of
exfoliation of deciduous teeth and that it would
go up to 12 to 13 years of age.
ii. Clinical examination.
iii. The need for constant review and recall on a
regular basis.
iv. In case of extraction of deciduous teeth due to
decay, etc. the need, advantages and importance of
space maintainers should be explained.

18. Caries control
Caries initiation can be prevented by diet
counseling,
topical fluoride application,
pit and fissure sealants
and educating parents (prenatal counseling and
postnatal counseling).

19. EXFOLIATION OF DECIDUOUS TEETH
Generally the deciduous teeth should exfoliate in about 3 months of
exfoliation of the one in the contralateral arch. Any delay more than that
should be considered with suspicion and the following should be ruled
out:
a. Over-retained deciduous/root stumps.
b. Fibrous gingivae.
c. Ankylosed/submerged deciduous teeth to be
assessed radiographically.
d. Restoration overhangs of the adjacent tooth.
e. Presence of any supernumerary tooth.

20. ABNORMAL FRENAL ATTACHMENTS
May cause the development of diastemas/excess spacing between the
teeth, which in turn may not allow the eruption of succedaneous
teeth. Surgical correction of the high frenal attachments is therefore
advised .
The tongue should also be assessed for ankyloglossia/ tongue-tie

21. LOCKED PERMANENT FIRST MOLARS
The permanent first molars may get locked distal to the
deciduous second molars, at times. Slight distal (proximal)
stripping of the deciduous second molar allows the
permanent first molar to erupt in their proper place.

22. ABNORMAL ORAL MUSCULATURE
a. Tongue thrusting habits or retained infantile swallow patterns are related to
prolonged breast feeding or bottle feeding by the mother. The same should be
withdrawn by 18-24 months of age.
b. Hyperactive mentalis action results in the lingual inclination of mandibular
incisors resulting in decreased arch length and an increased chance for the
developing anterior crowding. Oral habits such
as:
i. Thumb/digit/lip sucking the child can be distracted from indulging
in the same.
ii. Mouth breathing-the child can be given adequate medical attention, regarding
recurrent upper respiratory tract infection. Oral screens and the recently
introduced myofunctional appliances such as the pre-orthodontic trainers train
the child to breathe through the nose, thus allowing the proper development of
nasal passage, regression of adenoid mass and the development of a
shallow, broad palate.

23. Next class:
Space maintainers

24. • What is prevention?
• What is interception?
• Role of parent counselling?
• Caries control measures?